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Chapter 10
Injuries to the Thoracic Through Coccygeal Spine
Anatomy Review of the Thoracic Spine
• Thoracic spine consists of *
vertebrae
• Articulates with the cervical spine
at the top and the lumbar spine at
the bottom
• Cervical and lumbar portions
represent * curves, whereas the
thoracic portion is *
• The curves are important to the
overall strength of the spine
• Thoracic vertebrae are numbered
1-12 and have an intervertebral
disk located between each
vertebrae
Anatomy Review of the Thoracic
Spine
• The thoracic vertebrae have a relationship
with the 12 pairs of ribs
• The thoracic vertebrae, their
corresponding ribs, and the sternum form
a strong thoracic cage which helps to
protect internal organs such as the *
• Because of the union with the ribs and
costal cartilage, the thoracic spine is much
less mobile than the cervical or lumbar
regions
• The limited movement helps to make
injuries to this part of the body *
Skeletal Injuries of the Thoracic Vertebrae
• *of the vertebral body are most
common injury.
• Usually related to violent, ballistic
movements that are unique to
sports involving high velocities
• Such fractures usually occur at
junction *
• Athlete with recent history of
trauma to the region in conjunction
with pain or numbness should be
referred to a physician.
Skeletal Injuries of the Thoracic Vertebrae
• Scheuermann’s disease
is characterized by *
(abnormal amount of
convexity of the spine)
• * (lateral curve)
• Lumbar * (swayback)
Vertebral Fractures
• Fractures involving the * are extremely rare
• Result from a direct blow to the posterior thorax or extreme flexion of
the thoracic spine
• Significant soft tissue damage to the area can occur to the skin and
underlying muscles
• Sports such as football, soccer, or wrestling can have these injuries
• S/S: pain in the area, *, flexion, or * will be extremely painful, swelling
or discoloration to the area, muscle spasm to the injured area
• Treatment: RICE, remove athlete from play and re-evaluate after 24
hours, if * are present refer to physician immediately
Rib Fractures
• Such fractures are associated
with direct blows to lateral or
posterior thorax and can
occur anywhere along the rib.
• The ribs commonly fracture
near the *, which is the
weakest point.
• Posterior rib fractures can
potentially result in a
pneumothorax or a *.
Rib Fractures (cont.)
• Complications to rib
fractures are rare, but
when they occur they
can be quite dangerous
• Traumatic * – collapse
of a lung as a result of
air in the plural cavity
• * – bloody fluid in the
plural cavity
Rib Fractures (cont.)
Signs and Symptoms:
• Painful respiration.
• Deformity in the region of the injury, including a * or
depression where the normal contour of the rib
should be.
• Swelling and discoloration.
• Pain when rib cage is *.
Treatment:
• Immediately apply RICE (6-8in compression wrap)
• Refer for medical evaluation (*)
Sprains
• Sprains occur whenever a joint is forced beyond its
normal * resulting in damage to ligaments and joint
capsules.
• Evaluation of a sprain to the thoracic spine is difficult.
• A consistent symptom is painful respiration.
First Aid
• Apply *.
• If * (difficult or painful breathing) persists for more
than 24 hours, refer the athlete to a physician.
Strains
• Involve contractile tissue and
their support structures, such as
the * and intercostals.
• Are related to maximal
exertions.
• Result in muscle spasm and
point tenderness.
• First Aid
• Application of RICE to the
injured area.
Lumbar Spine Region
Anatomy Review:
• * vertebrae are
in lumbar spine.
• Articulate superiorly with
the thoracic vertebrae and
inferiorly with the sacrum
• Lumbar vertebrae are the *
moving vertebrae.
• The major ligaments are
the anterior and posterior
longitudinal ligaments.
Lumbar Spine Region (Sacrum)
• The sacrum consists of *
fused vertebrae.
• The sacrum connects the
spinal column to the pelvis.
• Right and left * (SI) joints are
formed by the union of the
sacrum and pelvis.
• Coccyx (tailbone) is most
distal portion of the vertebral
column.
• Injuries are more common to
the * than to the thoracic
Spondylolysis
• Spondylolysis is a defect in
the * (pars interarticularis).
• There are 2 pars
interarticularis on each
vertebrae (1 left and 1
right)
• Such defects compromise
the articulation between
two vertebrae.
• Also known as the “*”
defect
Spondylolisthesis
• A condition in which both neural
arches are affected and the
involved vertebrae slips forward
• Most common site is between *
and the *
• Symptoms include lower back
pain that worsens during
hyperextension, and radiating
pain to the buttocks and upper
thighs.
• Treatment includes rest, drug
therapy, *, exclusion from certain
sports, and surgery in severe
cases.
Traumatic Fractures: Lumbar Spine
• Such fractures are uncommon in sports.
• External blows may result in internal injury
especially to the *.
• Deep abdominal pain, *, and shock are signs
and symptoms of internal injury.
• Immobilize on spine board and transport to
medical facility.
• Fractures of the coccyx (*) result in severe pain,
point tenderness, swelling, and bruising. Refer
athlete to physician for evaluation.
Lumbar Region -- Strains & Sprains
• Strains and sprains
are the most common
soft-tissue injuries in
the lumbar spine.
• Major joints include:
• Lumbosacral
• *
• Sacrococcygeal
Lumbar Strains & Sprains (cont.)
Signs and symptoms include:
• Localized *.
• Pain that does not radiate into
buttocks or lower extremity.
• *(lateral lifting of the truck away
from the affected side)
First Aid
• Have athlete maintain a * position
with soft support for lumbar
region and application of ice.
• If not improved in 24 hours, refer
to physician.
Lumbar Disk Injuries
• A serious form of soft
tissue injury is a “*”
• Most commonly occurs
at L4 or L5.
• Anatomy of a disk
includes annulus fibrosis
(outer ring) and nucleus
pulposus (inner ring).
Lumbar Disk Injuries (cont.)
• Herniation results from a
weakened annulus that allows
nucleus pulposus to protrude
through the wall of the annulus.
• Protrusion may put * directly on
spinal nerves resulting in:
• Intense local or radiating pain.
• Sensory loss or * sensation in
lower extremity.
• Muscle spasm and postural
abnormalities.
Lumbar Disk Injuries (cont.)
First Aid
• Place athlete in supine or most comfortable
position. Support lumbar region with rolled towel or
other soft material.
• Apply * to lumbar region.
• Arrange for transport to medical facility.
• Not much can be done while in the field, but much
can be done to alleviate long term symptoms with
physical therapy and drug therapy